Implementation of Endoscopic Submucosal Dissection for Gastric Lesions in Norway

Abstract

Background and aims: endoscopic submucosal dissection is a minimal invasive method for an en bloc resection of dysplasia or early cancer in the stomach. It was developed in Japan in the 1990s, but thus far has not been widely adopted in western countries. the aim of this study is to report from the introductory phase of gastric endoscopic submucosal dissection in a small-volume scandinavian center.Material and Methods: the 15 first patients operated on with endoscopic submucosal dissection in the stomach at the university Hospital of north norway were consecutively registered in a prospective database and evaluated as a quality assurance study. the indications for the procedures were diagnostic or therapeutic.Results: three patients had benign lesions, three had low-grade dysplasia, five had high-grade dysplasia, two had neuroendocrine tumors, and two had early gastric cancers (t1b). the r0 resection rate was 83%. one neuroendocrine tumor was directed to surgery. no recurrences have been detected after the median of 6 months, and with the exception of one delayed bleeding being treated endoscopically, no serious complications occurred. two perforations were perioperatively closed with clips.Conclusion: this is the first report on gastric endoscopic submucosal dissection in scandinavia. preliminary results from an introductory phase indicate that endoscopic submucosal dissection for dysplasia or early gastric cancer may be conducted safely and with acceptable results even in a small-volume center, assuming that surgeons and gastroenterologists in a region direct cases to one individual who can learn this skill.

Endoscopic Submucosal Dissection for Esophageal Squamous Cell High-grade Dysplasia in a Patient with Plummer Vinson Syndrome

“…ESD is now gaining popularity in Scandinavian countries for gastric lesions. 25 Misjudgment of the indications or curability assessment can result in unfavorable patient outcomes.…”

Endoskopisk kirurgi

“…På den KLINISK OVERSIKT annen side tar endoskopisk submukosal disseksjon lengre tid å utføre, er teknisk vanskeligere og øker risikoen for perforasjon (4,5). I magesekken er imidlertid denne teknikken standard prosedyre fordi bedre plass gjør prosedyren enklere å utføre samtidig som en tykkere vegg reduserer perforasjonsrisikoen (6) (fig 2 a -d).…”

“…Heri ligger det en utfordring både for sentralisering på regionalt nivå samt for en større grad av funksjonsfordeling internt i de enkelte sykehusavdelinger og delvis på tvers av etablerte spesialitetsstrukturer. Flere nyere studier viser at innføring av endoskopisk kirurgi i vestlige land er mulig med akseptable komplikasjonsrater, men vi må regne med lengre operasjonstider i en innføringsfase (6,14,15). b) En homogen submukøs reseksjonsflate etter endoskopisk submukosal disseksjon bekrefter at det her kun dreier seg om dysplasi og ikke innvekst i dybden som ved invasiv cancer.…”

Expanded endoscopic therapy criteria should be cautiously used in intramucosal gastric cancer

“…Clinicopathological characteristics of intramucosal gastric cancer associated with LNM, which may be diverse in patients from different regions, should also be extensively investigated when applying endoscopic treatment for EGC to other areas. Few reports have been published outside of Japan and Korea ( 17 , 18 ). This study investigated the clinicopathological characteristics of intramucosal gastric cancer to identify LNM-associated factors and discuss if Japanese practice is suitable for patients outside of Japan and Korea.…”